York MP Introduces Legislation To End Postcode Rationing Of NHS Care

Hugh Bayley, who used to work as a health economist at the University of York, introduced his National Health Service (Right to Treatment) Bill under the “10 minute rule”. The Bill seeks to do three things:

To ensure that any medical treatment prescribed by a doctor will be provided by the NHS unless the Secretary of State for Health, or his medical and scientific advisers at the National Institute for Health and Clinical Excellence, say no.

To establish a national register of all cases where treatment is refused to promote more consistent provision of NHS services, and to act as a check on creeping privatisation.

To give patients a right of appeal to an independent tribunal if treatment is denied.

Hugh Bayley believes that the NHS should provide equal access to treatment, when prescribed as necessary by a doctor or other qualified clinician, to NHS patients wherever they live. He has seen a huge increase in the number of constituents complaining about treatment being denied by Clinical Commissioning Groups (formerly Primary Care Trusts). The problem is getting worse because of the fragmentation of commissioning introduced by the Government’s health reforms, and because the squeeze in NHS funding is increasing the pressure for explicit rationing of treatment.

During his speech in the House of Commons introducing the Bill, Mr. Bayley referred to three recent cases of postcode rationing brought to his attention by his constituents in York:

Zoe Bounds: a woman with two young children who had ovarian cancer in her teens and recently developed breast cancer was recommended by her consultant to have a double mastectomy to reduce the risk of the cancer spreading. The clinical commissioning group (CCG) agreed to pay for one breast to be removed, but NHS England, which is responsible for funding preventive surgery, refused to pay for the other half of the operation. On appeal, the CCG agreed to the double mastectomy.

Rebecca Beattie: was badly beaten by a former partner and suffered multiple fractures to her face and nose. She needed surgery to enable her to breathe properly, but funding was refused. It was only after appeal and exposure in local and national newspapers including The Sun that funding was made available.

Emma Willetts: needs a permanent catheter to empty her bladder. A temporary operation at Pinderfields hospital to stimulate her sacral nerve greatly improved her condition. Her individual funding request for a permanent operation to stimulate the nerve has been turned down by the CCG.. Her consultant points out that the cost of permanent catheterisation - including the cost of hospital admissions each time she gets a urinary tract infection - will be much greater than the cost of the operation to improve her condition.

Each of these cases illustrates the need for accountable decision making and for a patient’s right of appeal.

When introducing the Bill, Hugh Bayley MP told the House:

NHS expenditure per person is down in real terms from £2,043 in 2009-10, to £1,999 this year and is due to fall again next year to £1,986, according to figures prepared for Mr. Bayley by the statisticians in the House of Commons Library.

In 2012 and again this month Mr. Bayley asked parliamentary questions about the number of individual funding requests, but was told: “The data requested is not collected centrally.” [Hansard, 3 April 2014; Vol. 578, c. 793W.]

In 2012 Mr. Bayley carried out a survey of all the Primary Care Trusts in England to find out how frequently they refuse to pay for treatments recommended by NHS clinicians for their patients. 72% of PCTs (109) replied. The number of Individual Funding Request (IFR) approvals in 2009-10 was 51,661. The number of approvals in 2011-12 had fallen almost by half to 26,076. There is also enormous variation in approval rates. In 2011-12, 10 out of 109 PCTs approved 75% or more of IFRs, while seven PCTs approved 25% or fewer.

Hugh Bayley MP says:

“The survey revealed enormous variation in NHS provision across the country. Infertile couples in York have no access to assisted conception services, but it remains available free on the NHS elsewhere. Gastric band surgery is generally available to people whose body mass index is 40 or more, but in York you have to be much more overweight, with a BMI over 50, to get this operation. York’s NHS budget is lower per person than in neighbouring health areas, which makes a bad situation worse.

“The postcode lottery is unfair. It contradicts the founding principles of the NHS. We all pay national insurance and taxes on the same terms, no matter where we live, and we all have a right to NHS treatment on equal terms. Each time the NHS says no to a patient a little more public confidence in the NHS drains away. This has to change, and quickly.”